We then further explored with participants these unique features in the context of the I-PASS education bundle. Using a conceptual framework, we sought to delineate the distinctive features of ED handoffs. We used a mixed-methods needs assessment that included literature review, focus groups and a survey. We aimed to determine what modifications the I-PASS mnemonic and education bundle required to be adapted to the ED setting. 9- 11 Academic EM training centers require specialized educational interventions to teach and assess provider handoffs across the continuum of medical education. ED inter-shift handoffs involve coordination of care for highly complex patients under significant time constraints. 5- 8Īcademic emergency medicine (EM) training centers present unique barriers to safe handoff processes. 2 Smaller studies have shown some success in improving compliance with standardization and others have shown improvement in time of handoff or user satisfaction with the new handoff process. After implementation, the study demonstrated a 26% overall reduction of medical errors in the inpatient pediatric setting. The largest multicenter handoff study conducted to date used a bundle of interventions that included standardized education, the “I-PASS” mnemonic and an electronic handoff tool. 3 Furthermore, the Association of American Medical Colleges (AAMC) has highlighted the importance of handoffs in medical education with the inclusion of handoffs as one of the 13 Core Entrustable Professional Activities for Entering Residency. 2 Due to the importance of handoffs, the Accreditation Council for Graduate Medical Education (ACGME) has built an emphasis on teaching and assessing handoff competency into its Next Accreditation System. 1 In a large multicenter study, resident physician handoffs had a baseline medical error rate of 24 errors per 100 admissions and a preventable adverse event rate of four events per 100 admissions. Breakdown in communication is the leading root cause of sentinel events reported to The Joint Commission (TJC). Handoffs are unique, high-risk transfer of care events. Implementation and outcome research is needed to investigate if the I-PASS tool is feasible and improves patient outcomes in the ED environment. This study provides qualitative data in support of using the I-PASS tool and concrete suggestions for how to modify the I-PASS tool for the ED. With modifications for context, brevity, and clarity, the I-PASS system may be well suited for application to the ED setting. Most participants agreed that the I-PASS tool would be well suited to the ED setting. Themes from all qualitative sources converged to suggest changes for brevity and clarity. The survey yielded several wording changes to reflect contextual differences. Participants generally endorsed the order and content of the other elements of the I-PASS tool. We sought to identify the distinctive elements of ED handoffs and discern how these could be incorporated into the I-PASS system.įocus group participants agreed the patient summary should be adapted to include anticipated disposition of patient. We conducted a literature review, focus groups, and then a survey. This mixed-method needs assessment conducted at an academic ED explored the suitability of the I-PASS system for ED handoffs. We aimed to explore what modifications the I-PASS (illness severity, patient summary, action list, situation awareness and contingency plans, and synthesis by receiver) handoff system requires to be effectively modified for use in ED inter-shift handoffs. Emergency medicine residents are inadequately trained to handle these vital transitions. Academic emergency department (ED) handoffs are high-risk transfer of care events.
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